During the last three years, while planning this medical symposium to address a subject that has been a pharmaceutical conundrum for decades, I have been asked many questions. These two come up most often:
*Why did I decide to create a symposium around something that happened to me almost a decade ago, when a physician handed me a prescription for Ativan to offset insomnia and panic attacks, resulting in benzodiazepine dependence, withdrawal and recovery?
*How will Advocates For Social Reform have a positive impact on how these particular medications, once thought to be minor tranquilizers, are ‘appropriately’ prescribed?
Locating the 525 page transcript of Senator Ted Kennedy’s 1979 Senate Hearing on The Use and Misuse of Benzodiazepines, and finding absolutely nothing that followed up on this monumental discussion, is what led me into the extensive research that ultimately prompted The International Benzodiazepine Symposium (TIBS); in many ways carrying forward data presented those decades ago, along with what is now being revealed about long term benzodiazepine dependence.
My intention for this Symposium is to issue a call for further scientific research into benzodiazepines and other bio-psychiatric medications. We are not out to ‘bash benzos’, totally aware of their potential positive use in traumatic situations. We do not support efforts to castigate or litigate against the pharmaceutical companies who created benzodiazepines, as many patients have done. However, we do support legislation protecting patients with ‘Advised Consent’ information–as being done in Massachusetts.
The Symposium will delve into the complications that arise when benzos are coupled with other bio-psychiatric drugs. We will hear from people who have gone through the ‘benzo gauntlet’ to achieve recovery, and from those who continue to view their ‘benzos’ as lifesavers.
Special appreciation to our Program Medical Director, Steven Wright, M.D.; Kristi Miller, TIBS Project Manager; The St.Charles Health System/St. Charles, Bend , our co-sponsors, Kimberly Swanson, Ph.D., the Symposium’s St. Charles advisor, and Lisa Dobey of the St. Charles Foundation, for giving a home to The International Benzodiazepine Symposium 2017.
A Note from our Program Medical Director
The story behind TIBS is the story of millions around the world, who in good faith took advice from those of us prescribing benzodiazepines and have had serious consequences. They are not rare tragedies, but individuals whose lives have been altered by the very agents that were intended to help.
This symposium is designed to amplify these concerns with the best evidence-based practices in prescribing benzodiazepines. We will address the following questions in a balanced and substantial manner:
- Is there a role for benzodiazepine use for anxiety states and insomnia?
- For short term use?
- For long term use?
- What are non-benzodiazepine approaches to anxiety states and insomnia?
- How do these approaches compare to benzodiazepines in terms of efficacy and adverse effects?
- What are the best practices for treatment selection?
- What are the adverse reactions seen with benzodiazepine use?
- Identified early in the course of therapy?
- Identified after long-term use?
- What is the difference between ‘dependence’ and ‘addiction’ when it comes to benzodiazepines?
- How are benzodiazepine adverse reactions identified and treated, particularly during benzodiazepine withdrawal and post-withdrawal?
We understand there is a great need for improving prescribing practices for these potent medications, and are grateful to the St. Charles Health System for their commitment to Safe Prescribing Practices.
Our intention for this symposium is to seed initiatives through clinician and patient education, shared decision-making, evidence-based advocacy, potential regulatory reform, and an advanced research agenda to examine the clinical questions that really matter.
Steven Wright, MD TIBS Program Medical Director Addiction Medicine Medical Pain Management
Benzodiazepines are a class of psychoactive agents which bind to the GABA receptor of the brain, causing the receptor to become more sensitive to activation by naturally occurring gamma-aminobutyric acid (GABA). In the late 1950s Leo Sternbach accidentally discovered chlordiazepoxide (brand name Librium), the first of many of this drug category found to have potential benefit for anxiety, insomnia, muscle spasm, and seizures. Discovered much later, “Z drugs” – named that way because most generic names begin with the letter “Z” – are non-benzodiazepine compounds which also affect the GABA receptor but have a more favorable effect on sleep architecture compared to the benzodiazepines.
These substances have been used over many years, and indeed by 1977 benzodiazepines were the most prescribed class of medications in the world. Even today, however, their apparent benefit for the short term has led to long-term use in large numbers of individuals, a practice that has been challenged. Benzodiazepine use can result in serious adverse reactions, which have been well described, but are often not taken seriously as evidenced by the lack of knowledge, informed consent, and ability to respond to patient concerns by prescribers. Indeed it has taken a crisis – the prominent role benzodiazepines have had in the opioid overdose epidemic – to redirect our attention to these medications.